Child malnutrition in Iraq

by Chris Bertram on November 22, 2004

One of the points made most insistently by critics of the Lancet study was that they disbelieved the claim that infant mortality had increased since the war. Heiko, a contributor to one of Dsquared’s threads , wrote: “I do believe infant mortality may have dropped (though maybe not halved as yet), because a lot of things are available now that weren’t before the war.” The Washington Post has now published an article suggesting that there has been a dramatic rise in child malnutrition since the war:

Acute malnutrition among young children in Iraq has nearly doubled since the United States led an invasion of the country 20 months ago, according to surveys by the United Nations, aid agencies and the interim Iraqi government.
After the rate of acute malnutrition among children younger than 5 steadily declined to 4 percent two years ago, it shot up to 7.7 percent this year, according to a study conducted by Iraq’s Health Ministry in cooperation with Norway’s Institute for Applied International Studies and the U.N. Development Program. The new figure translates to roughly 400,000 Iraqi children suffering from “wasting,” a condition characterized by chronic diarrhea and dangerous deficiencies of protein.

The article makes grim reading for anyone concerned about winning the hearts and minds of the Iraqi people:

“Believe me, we thought a magic thing would happen” with the fall of Hussein and the start of the U.S.-led occupation, said an administrator at Baghdad’s Central Teaching Hospital for Pediatrics. “So we’re surprised that nothing has been done. And people talk now about how the days of Saddam were very nice,” the official said.

{ 65 comments }

1

Barry 11.22.04 at 11:50 am

Paging Dr. Lott……

2

billyfrombelfast 11.22.04 at 1:57 pm

3

Deb Frisch 11.22.04 at 2:56 pm

It makes even grimmer reading for anyone concerned about the Iraqi people.

4

Javier 11.22.04 at 3:52 pm

Check out Oxblog’s skeptical questioning of the data behind that article here.

5

tom 11.22.04 at 4:27 pm

What is wrong with this site. Whole lines are missing and partially missing from posts.

6

Zackary Sholem Berger 11.22.04 at 4:31 pm

Oxblog asks the right questions here. One could imagine an incentive to exaggerate the post-invasion malnutrition rate, and underestimate the pre-invasion rate. One needs to know what the denominator was, first of all, and then how the data were gathered — what control was exercised, if any, by the pre- and post-invasion Iraqi Ministry of Health.

I don’t disagree that the claimed result is plausible, just that I get awfully frustrated with press reports based on results still unpublished in a refereed journal. Contrast this with the reports about the Lancet article.

7

Matt McGrattan 11.22.04 at 4:41 pm

I’m curious.. how often do the pro-war bloggers (OxBlog, etc.) get all sceptical when faced with statistics that support rather than cast doubt upon their position?

Whenever one of these reports gets published we are suddenly surrounded by keen amateur experts in epidemiological methodology whose position often amounts to little more than “I don’t like these statistics therefore they must be wrong…”.

8

Zackary Sholem Berger 11.22.04 at 5:02 pm

I know OxBlog is not the most unbiased of critics, but one ought to accept a critique if it’s well-founded. I’m no fan of the war or its outcome, but I am an epidemiologist (defending my PhD in a month or so), and I can tell you that without knowing the facts I mentioned above, the validity of the results mentioned in the Post would be significantly weakened.

9

Donald Johnson 11.22.04 at 5:07 pm

Assuming this report is true, why didn’t it show up in the Lancet study? That’s a seriously-meant question–the two things that surprised me about the Lancet paper was that the death rate from American violence was so high and that the death rate from drinking dirty water was so low.

I think the Lancet study makes a pretty convincing case for a skyrocketing death rate from violence, but why did they miss the deaths from diarrhea? Not enough children in the sample?

10

Matt McGrattan 11.22.04 at 5:15 pm

Zachary:

Of course, and there is, as you say, far too little attention paid to the details when these studies are reported in the popular press.

There’s nothing wrong with subjecting studies (epidemiological or otherwise) to serious informed scrutiny — almost as a matter of routine.

My problem is with the systematic one-sideness of much of the current ‘scrutiny’ and the way in which shoddy and ill-informed critiques of the type we have seen surrounding the Lancet study can find their way out into the broader world and become accepted as ‘fact’.

11

nic 11.22.04 at 5:16 pm

Matt, nevermind statistics, what I find impressive is that people who swallowed things like the WMD / Al Qaeda in Iraq allegations, the belief that the Bush admnistration was in good faith, the belief that the basic driving force for war in Iraq was a humanitarian concern, etc. etc. those people now pretend to get all Champions of Healthy Skepticism at the mere hint that maybe things are not going as well as those who had an interest in supporting the war predicted. Like they were such outrageous suggestions, too. You’d almost think they were doubting a report that aliens had landed in Baghdad.

And they still get treated as if they were intellectually honest. That’s what’s more amazing.

12

Zackary Sholem Berger 11.22.04 at 5:38 pm

Actually, the Lancet study did find increased child mortality. To quote the authors:

“The increase in reported infant mortality among interviewed households is consistent with a well-documented pattern seen in armed conflict. Many mothers reported that security concerns led them to deliver their children at home since the invasion…”

The report might not have been mentioned because infant mortality is different from the endpoint of the study reported in the Post, severe malnutrition among children.

By the way, references 10, 11, and 12 in the Lancet paper refer to infant and child mortality. I don’t know what those refs say about malnutrition.

13

dsquared 11.22.04 at 5:47 pm

I think the Lancet study makes a pretty convincing case for a skyrocketing death rate from violence, but why did they miss the deaths from diarrhea?

They did find an increase in infant mortality; the increase in violent deaths was even greater, and adult deaths were the more significant driver of the overall death rate.

14

dsquared 11.22.04 at 6:01 pm

Looking at the Oxblog critique, most of it is the same blame exercise that they tried with the Lancet study; trying to import political decisions about who counts as a “proper civilian fatality caused by the coalition” into what ought to be a straightforward scientific measure of who’s consuming oxygen.

However, they do make one good point that I’d like to get straightened out; what is the period to which this number refers; when was the fieldwork carried out? It looks as if there is decent reason to believe that it’s a study carried out in May 2003 and which concentrated on Baghdad, which would make it still an important datapoint (and one which backs up the Lancet study), but not necessarily as informative about conditions today as the Washington Post story implies it is. Although obviously, the Washington Post has come up with supporting quotes from recent interviews with (Baghdad) hospital staff, which suggest that things haven’t got much better.

Chris is dead right, though; this makes the Lancet estimates more credible.

15

dsquared 11.22.04 at 6:05 pm

Actually, I’m not so sure; the guy quoted in the WaPo and AP stories is Jon Pedersen of the Fafo institute in Norway, which suggests that the malnutrition data is advance release from this survey and the fieldwork was done between March and June of this year.

16

md 11.22.04 at 6:11 pm

White man’s burden revisisted.

17

md 11.22.04 at 6:11 pm

White man’s burden revisisted.

18

md 11.22.04 at 6:12 pm

White man’s burden revisited.

19

Zackary Sholem Berger 11.22.04 at 6:38 pm

dsquared,

The Post says:

After the rate of acute malnutrition among children younger than 5 steadily declined to 4 percent two years ago, it shot up to 7.7 percent this year, according to a study conducted by Iraq’s Health Ministry in cooperation with Norway’s Institute for Applied International Studies and the U.N. Development Program. The new figure translates to roughly 400,000 Iraqi children suffering from “wasting,” a condition characterized by chronic diarrhea and dangerous deficiencies of protein.

What is the source of that acute malnutrition prevalence from two years ago? It’s not on the Fafo Institute site. The UNICEF site hints at some sort of study in their statistics labeled 1995-2002, so I’m starting to think what was used is the Ali et al. studies referred to in the Lancet paper –but no, that can’t be it either, because one of them is from the year 2000, and one of them is from 1993-1998.

I must be missing something obvious, but where’s the reference to the earlier study?

20

roger 11.22.04 at 7:31 pm

The oxblog skepticism amounts to nothing more than claiming, without any evidence at all, that the decline from 11 percent to 4 percent is a pseudo-statistic.

Hmm. I remember, in the 90s, that the right claimed that the 11 percent was a pseudo-statistic. Back then, groups that petitioned to end the sanctions were told that the number of children supposedly dying was ridiculously exaggerated by Saddam.

Man, that Saddam is a statistical genius. First he ups the number of children dying for his own diabolical reasons, and then, getting into his time machine in his prison cell, he lowers the number of deaths using the same statistics.

No wonder we had to send Batman over there to flatten him!

In the meantime, though, remember — those kids are dying in schools that the Americans have given new paint jobs to. The good news is, again, unreported in the liberal media. Why, as those kids bleed their lives away, they are praising their American liberators for the wonderful surroundings and the occasional electricity in which they do it.

What I would like to know is — are the Americans using the same Iraqi mass grave diggers that Saddam employed as they dump the “insurgent” bodies in Falluja. Wouldn’t that be neat? Getting an Iraqi industry back on its feet again.
We really are a highly moral people.

21

roger 11.22.04 at 7:45 pm

ps — for a pre-propaganda view of the number of deaths under the Saddam regime — one that argues for a lower number, which would argue that the increase to 7.7% is, indeed, an indictment of occupation incompetence — see this article by Matt Welch in a 2002 issue of Reason, http://reason.com/0203/fe.mw.the.shtml

22

abb1 11.22.04 at 7:56 pm

What I would like to know is — are the Americans using the same Iraqi mass grave diggers that Saddam employed as they dump the “insurgent” bodies in Falluja. Wouldn’t that be neat? Getting an Iraqi industry back on its feet again.
We really are a highly moral people.

This is so true. But there isn’t much hope: I’ve read somewhere that stupid eye-rakies in Fallujah refuse to get paid for digging mass graves – not supposed to take money for burials.

How do you build the bright capitalist future with unenlightened folk like that?

23

Javier 11.22.04 at 8:12 pm

The oxblog skepticism amounts to nothing more than claiming, without any evidence at all, that the decline from 11 percent to 4 percent is a pseudo-statistic.

Perhaps I’m wrong here, but Oxblog is claiming that the WaPo story relies on statistics collected under Saddam, which means that while they might be accurate, we should approach them with a good amount of skepticism. This sounds about right to me.

24

Javier 11.22.04 at 8:14 pm

The oxblog skepticism amounts to nothing more than claiming, without any evidence at all, that the decline from 11 percent to 4 percent is a pseudo-statistic.

Perhaps I’m wrong here, but Oxblog is claiming that the WaPo story relies on statistics collected under Saddam, which means that while they might be accurate, we should approach them with a good amount of skepticism. This sounds about right to me.

25

dsquared 11.22.04 at 8:22 pm

These are statistics for infant malnutrition, not mortality. They are collated by weighing and measuring children. Unless the Iraqi propaganda department had developed a method by which Iraqi children were able to convincingly lie about their height, I am not sure how this argument could be made to work.

26

Zackary Sholem Berger 11.22.04 at 8:32 pm

roger:

see this article by Matt Welch in a 2002 issue of Reason, http://reason.com/0203/fe.mw.the.shtml

Nice article, but it doesn’t say much about the prevalence of acute malnutrition two years ago, the baseline quoted in the Post article. I’m not smart enough to figure out what study they’re talking about. Still looking for it, though . . .

27

Zackary Sholem Berger 11.22.04 at 8:44 pm

Unless the Iraqi propaganda department had developed a method by which Iraqi children were able to convincingly lie about their height, I am not sure how this argument could be made to work.

You’re right, that doesn’t seem plausible. But there are a lot of other, more real-world selection biases to choose from, right? One could imagine that, say, malnutrition was more prevalent in certain regions of Iraq, or in hospitals, or in urban centers, etc., and the Health Ministry encouraged use of those children in the studies.

It doesn’t even need to be as devious as that. Perhaps the field workers in the baseline study neglected to ferret out such sources of selection bias, and confined their interviewing to the regions with a higher degree of consent, which tended to be those with a higher prevalence of malnutrition.

Any critique by a supporter of the Iraqi war (which I’m not) is not ipso facto ridiculous, as tempting as it might be to think that. OxBlog pointed out that the original source for the baseline figure might be helpful to have, and I haven’t seen anything yet to argue that point.

28

roger 11.22.04 at 8:48 pm

Zachary, the point of the article is that the Oxblog skepticism is a volte face from the former skepticism about Saddam H. — the former line was that Saddam exaggerated the suffering of the Iraqis, and that the stats were inflated — presumably including stats related to the malnutrition of children. Now, suddenly, the stats understate the real suffering under Saddam. Conveniently, this makes the 4 percent quoted by the WP seem like some Saddamist propaganda. Since the Oxblog group cites no countering stats, their whole contention rests on motivation. Since formerly the claim was that a, Saddam was exaggerating, I’m saying that there’s no justification for the current claim that b., Saddam is now understating. So the Oxblog debunking amounts to nothing more than a crude attempt to deceive about the increase of around 75% over the last unoccupied year in Iraq.

29

Zackary Sholem Berger 11.22.04 at 9:22 pm

Roger,

I’m willing to accept your suspicions of OxBlog’s motives. So let’s leave them out of this. The only reason I brought up OxBlog is that I thought they made a good point. In the next paragraph, I’ll pretend it’s my own idea.

The problem I wanted to point out is this. In the Washington Post article, it was said that the quoted study demonstrated an increase in acute malnutrition among children of 7.7 percent from two years ago.

I was wondering what study of two years ago was meant. I assume either (a) I’m not well-informed enough to find it; or (b) the Post article is inaccurate in this (small) respect. When the baseline study is pointed out to me, I would be interested in reading it, to see whether any epidemiologic biases are muddying the results.

That’s all I was curious about.

30

ruralsaturday 11.22.04 at 9:30 pm

Yes Javier – skepticism for the opposition; but pure faith and submissive credulity for the “official” statistics released, or withheld for strategic purpose, by the “good guys”.
Isn’t there a clinical psych term for that pathologically narrowed focus? Where the limits of context are artificially truncated, so that events and motives can be viewed as isolated within controllable parameters? And then one for the character weakness that gives in to that fake version of the real – because it’s safer, more comfortable, and promises greater reward.
Eventually, if we can just get through this messy part.

31

ruralsaturday 11.22.04 at 9:42 pm

Yes Javier – skepticism for the opposition; but pure faith and submissive credulity for the “official” statistics released, or withheld for strategic purpose, by the “good guys”.
Isn’t there a clinical psych term for that pathologically narrowed focus? Where the limits of context are artificially truncated, so that events and motives can be viewed as isolated within controllable parameters? And then one for the character weakness that gives in to that fake version of the real – because it’s safer, more comfortable, and promises greater reward.
Eventually, if we can just get through this messy part.

32

vernaculo 11.22.04 at 9:46 pm

Yes Javier – skepticism for the opposition; but pure faith and submissive credulity for the “official” statistics released, or withheld for strategic purpose, by the “good guys”.
Isn’t there a clinical psych term for that pathologically narrowed focus? Where the limits of context are artificially truncated, so that events and motives can be viewed as isolated within controllable parameters? And then one for the character weakness that gives in to that fake version of the real – because it’s safer, more comfortable, and promises greater reward.
Eventually, if we can just get through this messy part.

33

vernaculo 11.22.04 at 9:52 pm

Yes Javier – skepticism for the opposition; but pure faith and submissive credulity for the “official” statistics released, or withheld for strategic purpose, by the “good guys”.
Isn’t there a clinical psych term for that pathologically narrowed focus? Where the limits of context are artificially truncated, so that events and motives can be viewed as isolated within controllable parameters? And then one for the character weakness that gives in to that fake version of the real – because it’s safer, more comfortable, and promises greater reward.
Eventually, if we can just get through this messy part.

34

vernaculo 11.22.04 at 9:55 pm

Consistent 404, which was in retrospect bogus as all get out. Sorry.

35

roger 11.22.04 at 10:01 pm

Zachry, fair enough. I imagine there should be something about this on the websites of the parties involved — for instance, Norway’s Institute for Applied International Studies. I’d go there to check out the baseline.

But imagine, for a second, that you are satisfied. Is that it? What I can never understand about the pro-occupation people is that, given the goals to which they say they are committed, they don’t find stats like these infuriating enough to demand, from their own side, a much higher standard of competence. Nobody says you have to give up your reasons for supporting the war. But why not give a little feedback to the side that you support? It never happens. There was a story in the Independent yesterday. The reporter is embedded with a marine corps around Falluja. She obviously liked them. They are all gung ho. But the captain said, what I can’t figure out is why they aren’t spending the 18 billion in reconstruction money they were supposed to. What is the hold up?

Exactly. This man is committed as committed can be. But he at least is asking the right questions, rather than defending the indefensible.

36

Zackary Sholem Berger 11.22.04 at 10:27 pm

Roger,

I imagine there should be something about this on the websites of the parties involved —for instance, Norway’s Institute for Applied International Studies. I’d go there to check out the baseline.

Um, yes. Hence my puzzlement in my past comments about my not being able to find said information on said websites (either Fafo or UNICEF). I’ve been there and elsewhere. I’ve looked.

Look, if anyone out there can tell me which study of two years ago is meant, I’ll swear up and down that I’m not a nasty ol’ right-winger. (Which I’m not.)

37

Javier 11.23.04 at 2:53 am

Yes Javier – skepticism for the opposition; but pure faith and submissive credulity for the “official” statistics released, or withheld for strategic purpose, by the “good guys”.

Do you have any evidence that the writers for Oxblog had uncritical faith in statistics that worked to justify the war on humanitarian grounds? I’m not willing to condemn them so easily unless I do have such proof, which I currently don’t. Maybe you can drum up some. Anyway, it is mostly irrelevant to the topic–are the statistics in question biased? If Oxblog is right, then we have reason to suspect that they are.

38

Matthew2 11.23.04 at 9:53 am

Aerial bombing and guerilla war leads to child death and malnutrition? I’ll say.
We’ve all learned some really important lesson there.

I think we now need a peer-reviewed study to assert the effect of napalm bombing and mass anarchy on the auto industry and hospital lighting supply, although it should be approached with healthy skepticism.

39

liberal japonicus 11.23.04 at 10:59 am

javier, I don’t know if this constitutes proof, but check out this Adesnik post from 4 Feb 2003. If Oxblog is irrelevant to discussion about Iraq, it is because they have made themselves so.

40

jet 11.23.04 at 1:05 pm

Roger,
“what I can’t figure out is why they aren’t spending the 18 billion in reconstruction money they were supposed to. What is the hold up?”

In the 15 minutes or so of Fox and Friends, a Fox morning show, I watch every morning, they have blasted the administration and Congress for not getting more funds into actual reconstruction. This is a common theme on Fox.

There is feedback on the pro-war side, you just have to listen to the pro-war news sites to hear it. I wouldn’t bet my house on it, but I’m pretty sure even Drudge ran an article asking a similiar question.

41

jet 11.23.04 at 1:08 pm

Crooked Timber should let someone fix the mt-comments.cgi so that it posts a response page THEN processes the comment, or does both at the same time. I bet 5 minutes of rewrite would fix all the multiple posts.

42

Tim Lambert 11.23.04 at 1:29 pm

I deal with the Oxblog post in an update here.

43

Mr. C 11.23.04 at 2:43 pm

Oxblog smoksblog. Here’s what is going on in Iraq. One side is trying to rebuild Iraq and provide an atmosphere where the young don’t go hungry. Another side is working hard to prevent that from happening. Ask yourself two questions 1. Which side is right and which side do I support?

44

Zackary Sholem Berger 11.23.04 at 3:31 pm

If anyone would like to know about the methdological difficulties of conducting studies of child nutrition in Iraq, and determining secular trends, this paper would seem to be a good choice (I haven’t read it, though, and it’s not available on line):

_______

Author
Garfield R.

Institution
Columbia University, New York, NY 10032, USA.

Title
Studies on young child malnutrition in Iraq: problems and insights, 1990-1999.

Source
Nutrition Reviews. 58(9):269-77, 2000 Sep.

Abstract
Many reports on Iraq proclaimed a rise in rates of death and disease since the Gulf War of January/February 1991. Several of the studies on nutritional status are not readily accessible, and few have been compared to identify secular trends. Here, 27 studies examining nutrition among Iraqi children in the 1990s are reviewed. Only five studies were found to be of comparable methodologic quality. These are analyzed to identify major trends in child nutrition between August 1991 and June 1999. Limitations of existing studies and recommendations for future studies are discussed.

_____

Hurrah for Google Scholar! I looked through some of the literature on the topic (not deeply, I admit) and I’m even more confused how we’re supposed to understand the trends of child malnutrition.

For the Nth time: yes, the finding reported in the Post is plausible. (And for that matter, I think the Lancet paper was impressive. And I voted for Kerry. Enough now?) But I keep wondering where the epidemiologic baseline is coming from.

Perhaps this is the wrong forum to express such doubts…at least without having one’s ideological bona fides questioned!

45

Tim Lambert 11.23.04 at 4:10 pm

Zackary, there is some information about the 2002 nutrition survey here.

46

nic 11.23.04 at 4:56 pm

What, 45 comments and still no one asked “how many malnourished children is democracy worth”?

Come on, keyboard warriors, you can do better than nitpicking about statistics. You know you’re right, so why bother with numbers? It’s down to good and evil, and malnourished children and civilian deaths are good by definition since the goal is the good of the Iraqis and doubting that for even a moment is evil. There you go, that’s what’s really happening in Iraq. It’s so simple, don’t try and complicate it by asking questions!

47

Zackary Sholem Berger 11.23.04 at 5:07 pm

Tim,

That’s a link to the article in the Post, which doesn’t say much of anything about the 2002 study.

But now, trying to see what you might have found there that I missed, I see a sentence in the article I didn’t notice before: “The [Nutrition Research Institute at the Health Ministry] has been involved with nutrition surveys for more than a decade; the latest one was conducted in April and May but has not been publicly released.”

Thus I assume that both this year’s results and the results of two years ago are not publicly available. (They certainly aren’t anywhere on the Web.) Since, as I pointed out above, there might be many possible biases in such data, I think skepticism about these particular studies is warranted until one can judge selection methods and the like.

Again, the result is plausible, and the situation in Iraq is undeniably awful. But anyone who reads the epidemiological literature should realize what biases can creep in in the best of situations. I wouldn’t doubt that the same might be happening here.

. . . Oh! Here’s something interesting – a report from WHO entitled “Health Conditions of the Population in Iraq Since the Gulf War.” According to this report, the proportion of wasting among children in Iraq was 3% in 1991 and 12% in 1995. The cite is the Food and Agriculture Organization (a UN org, I assume), but again, no selection methods are given.

I’ll shut up now. The point once more: skepticism about the result is warranted for epidemiologic reasons, and does not necessarily indicate hard-heartedness or Rumsfeldism.

48

Matt McGrattan 11.23.04 at 5:34 pm

Zackary, for what it’s worth, if you do find anything substantive out [once you can get hold of the relevant data] i’d be really interested to hear it.

Just because some people seem to have ‘faith-based’ reasons for dismissing the Lancet report and this one there’s no reason not to subject this stuff to all relevant critical scrutiny… finding the data questionable or unsupported without further information doesn’t automatically put you in the OxBlog camp :-)

49

Tim Lambert 11.23.04 at 6:17 pm

Oops sorry, I meant to link to this page

50

nic 11.23.04 at 6:44 pm

The point once more: skepticism about the result is warranted for epidemiologic reasons, and does not necessarily indicate hard-heartedness or Rumsfeldism.

Of course, you’re right, but you cannot ignore for many of the so-called “skeptics” about this stuff that becomes the *entire* point of debate, and a reason to ignore the obvious facts about the situation in Iraq being awful. You may have only an interest in accuracy, but you cannot ignore for others it’s plain reflexive denial and diversion tactics, with themselves first of all, to justify to themselves their position. It’s like by pretending to be really so very interested in refuting the data they can wish away the problem of dealing with the real consequences of their ideal “humanitarian effort” cover. Look at the Lancet study controversy, the issue of civilian casualties in modern warfare and compliance with Geneva conventions and all has been swept under the carpet, as if it was *unthinkable* that there were more than a few hundreds, and unthinkable that laws could still apply to military operations. That’s what’s maddening.

I don’t have a problem with people questioning data. I have a problem with the cynical disregard for what that data, with its potential errors or biases, actually refers to. Because even if all available data was completely biased and worthless, one thing is sure and evident to anyone not living under a rock: there is no parallel universe Iraq in which there were no or insignificant numbers of civilian casualties from the invasion, and there is no Iraq in which malnutrition is no longer a significant problem. And poverty, and terrorism, and so on. I never expected the invasion to turn Iraq into a happy peaceful democracy overnight, but that’s exactly what we’ve been sold and are still being sold, some mythical end in sight for which all sacrifices — on the skin of others, incidentally — are worth it. Old style imperialism was a bit more honest at least.

Excuse my rant, I’m an old-style pacifist, maybe I should just get with the program and join the celebration for January elections, hurrah…

51

Zackary Sholem Berger 11.23.04 at 6:47 pm

Ah, that’s more like it! Thanks! Here’s what seems to be the central paragraph about how the study was done:

“The new data on child health comes from a UNICEF-supported household survey of malnutrition among children under five that was conducted in the south and center of Iraq by the Iraqi Ministry of Health and the Central Statistical Organization in February 2002.”

Now I’d like to know if there’s anything different about the south and center of Iraq compared to the rest of it. (I guess that’s excluding the Kurdish region? Excuse my Iraq-ignorance.)
And, of course, there’s still the nagging question about selection methods.

The link to the full study is broken, though. So frustrating! I’ve e-mailed UNICEF to see if I can get a copy.

52

abb1 11.23.04 at 7:23 pm

Old style imperialism was a bit more honest at least.

It wasn’t. The old-style imperialism was carried out under exactly the same pretext with only slightly different terminology: to civilize savages, to teach them benefits of the law and order, and so on.

53

George 11.23.04 at 11:43 pm

“One of the points made most insistently by critics of the Lancet study was that they disbelieved the claim that infant mortality had increased since the war.”

Really? Isn’t that obvious? If terrorists are blowing up the countries infrastructure, bombing the water treatment plants, and targeting anyone who’s trying to run government services, then I would have thought it to be expected that child mortality, and mortality from decease and terroist attacks amongst the rest of the population, would go up. That’s indeed what I thought made up a lot of this ridiculous Lancet figure. But as we know, most of these deaths were absurdly blamed on US arial bombardments; I think the events in Falluja, and the fact that we now have documented evidence of locals claiming, without embarrassment or hesitation, that the dead men found with guns they are digging graves for, were woman and children, of just civilian men out for a walk, puts the Lancet study to bed once and for all. This is precisely why this sort of study has never been conducted in a live war zone before, and why it must never happen again to avoid phoney statistics being used for propagandist purposes in this way. The Lancet authors knew this, but they pressed ahead anyway – shame on them.

This child malnutrition figure also puts shame on anyone who supports the terrorist, and their campaign to assassinate government officials, aid workers like Margaret Hassan, and target the key infrastructure needed for the Iraqi people. Nobody could now credibly argue that a troop pull out is the right thing for Iraqis, or that it was wrong to go into Falluja and deal with these fuckers, so that aid agencies can return to Iraq without fear of being beheaded. I’m glad that’s over and done with.

54

Donald Johnson 11.24.04 at 1:52 am

Real convincing rant there George. Glad you set us all straight.

55

roger 11.24.04 at 3:24 am

George, have to disagree. First, the question isn’t whether to side with Zarqawi or the Americans. There are plenty of other groups in Iraq, from Sadr and Chalabi, that bizarre duo, to the Communists. Second, both the terrorists and the Occupiers are using the same tactics — terrorist bombing, torture, etc. In the American case, there are reports that the troops used white phosphorus in Fallujah, making that form of warfare the moral equivalent of Saddam’s war against the Kurds. Third, the U.S. has banned aid workers from its prison and holding centers, bombed hospitals, and kept the red cross from delivering timely aid in Fallujah. So if you are concerned about Iraqis getting help from aid workers, you might be interested to know that the Red Cross has denounced both the insurgents and the Americans.

Not only do I support a troop pull out, I believe that if a schedule of withdrawal had been drawn up last year, there would be less violence this year. After the destruction of Fallujah, the presence of occupation troops has moved from being arguably positive to being inarguably negative. They are simply being used as instruments of the ethnic cleansing of the Sunnis. A weapon in the hand of an ex-Ba’athist appointed by the American chosen IGC. There’s no difference between Iraq and, say, American support for the death squad regimes in El Salvador.

56

vernaculo 11.24.04 at 5:30 am

Jet- Thank you from all of us.

Jet- Thank you from all of us.

Jet- Thank you from all of us.

Javier-
My sincerest compliments for your decorum and insistence on accuracy.
A lot of us are so far outside any truly verifiable system of information, and unskilled in the technical processes of verification anyway, that it requires an emotional insistence and suppression of doubt that has no basis other than intuition, or hope, to take any kind of stand at all.
Still, the US government is by its own admission no longer concerned with consensus reality, only the fabrication of its own. Under that circumstance emotional truth may prove to be more accurate than any statistic.
I admire those who wade in to the effluent stream and analyze it. But it is effluent. That it has bits of identifiable fact in it doesn’t counteract the stench.

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George 11.24.04 at 8:52 am

I’d have to say you’re wrong on that, Roger. Of course, the legal international security forces are not in anyway using the same tactics, or are equivalent to, the terrorists they are trying to stop. You will already have seen the extraordinary lengths the US has gone to protect civilians in the critical operation to secure Falluja for the Sistani backed elections, so I don’t have to mention that.

The whole operation was designed to rid the town of the illegal insurgency that was using Falluja as a base to launch attacks on Iraq’s state infrastructure, to assassinate anyone working for the legal government, and murdering anyone trying to rebuild the country. Al Qaeda’s headquarters have been discovered, along with their torture cells, removing any doubts some may have had about the rightness of the mission. There are of course mistakes and various incidents that don’t always meet the extremely high standards we expect, which are to be investigated, but clearly there is no moral equivalence between the US forces and the terrorists, and it would be absurd for anyone to suggest there was.

The red cross do indeed have access to prisoners. The Americans very much want the aid agencies to come back to Iraq, which is why the Falluja operation was such a necessity. You are right that it is an irony that aid agencies based in London – that have nobody on the ground in Iraq, and release statements based on what they have picked up off the evening news – would voice concerns about such a critical operation for the future of Iraq. But that is the nature of the beast, I’m afraid. In the case of the Iraqi red crescent trying to get into Falluja, it was extremely impractical and dangerous for them to be roaming the streets at that time; the Iraqi ministry of health was already taking case of business, which is why initial reports of a humanitarian crisis proved totally unfounded.

White phosphorus is a standard fireball weapon used on enemy bunkers and vehicles, and is not equivalent to a chemical weapon in any sense – that’s why you don’t have to wear protective equipment like a chemical suit to use it, and why there is contamination. To compare the careful use of this weapon to the deliberate and indiscriminate gassing of 7000 civilians in Halabja, would be crass in the extreme.

I was pleased to have seen the Iraqis object to any sort of time table on the withdrawal of the international security forces at the Egyptian conference. To do so would have given the terrorists a date which they could plan to hold out until, which would embolden them.

We should never let down brave Iraqis democrats, such as Dr Allawi, who opposed Saddam’s regime every day it was in power over 25 years; especially at this extremely important time for Iraq. The elections that some falsely claimed would never happen, leaving egg on their face, are only weeks away. We can only leave when Iraq is victorious.

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nic 11.24.04 at 9:16 am

I’m glad that’s over and done with.

Yes, reality is so antiamerican. Let’s kill it too.

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roger 11.24.04 at 3:21 pm

George, from the bottom first:
The incursion into Falluja was objected to by Iraq’s current “interim” president, while it was supported by Allawi — who is misrespresented by your account. He isn’t a brave man who opposed Saddam Hussein, but a cowardly hit man for Saddam Hussein who turned against him and proceded to employ exactly the tactics that the insurgents now employ against the Iraqi/American government.

The invasion of Fallujah was not, as you say, an example of humanity. Rather, it was designed to be inhuman. First, no effort was made to involve any agency in the construction of refugee camps before the assault, even though the Americans announced it in order to drive around 200,000 people from the city. Those people underwent a culling, as Americans wouldn’t allow young men to leave. Then, the assault began with the bombing of a hospital. The heavy use of force has the consequences we can see on this site: fallujapictures.blogspot.com/ . Judge for yourself about the ferocity of the attack.
The use of white phosphor has the effect, according to the San Francisco Chronicle, of burning the skin — of, in effect, operating like napalm. So yes, it is like Hussein’s use of chemical warfare. It is not a harmless substance, nor is meant to be.
The ghost prisoners at Abu Ghraib have been admitted to by the Pentagon. They were specifically kept from the Red Cross.
As for the cages and torture chambers found in Fallujah — I have no doubt Zarquawi’s group uses torture. And I have no doubt the Americans do, too. As for the Mukhabaret that the CIA is reconstructing, I suspect they probably do too. I agree that “we should never let down brave Iraqis democrats.” That is why we should support the overthrow of Allawi through peaceful means. One way of doing this is to support letting Al Jazeera and other media operate in Iraq — at the present time, Allawi’s government, operating according to the traditional Saddamist template, is trying to suppress any media that isn’t pro-government, as well as using the courts and various militia to ban or kill his opposition.

Hopefully, the election to come will spin out of the hands of the Americans. In which case, we might have an interim government that demands a timetable for withdrawal. This is probably much too optimistic a hope — the Americans have managed many a faked election, and I expect this one to be run on the Marcos standard. In the run up to this one, however, the Americans are using a tool even I did not expect — the exaggeration of religious differences, the identification of Allawi with Shiite force against the Sunnis, and the general tactic, so successful for Milosevic in Serbia, of exterminating some enemy. Clever, inhumane, and ultimately what one would expect from the Bush crew.

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Tom Doyle 11.24.04 at 3:45 pm

Zachary,

About the article by Richard Garfield, “Studies on young child malnutrition in Iraq: problems and insights, 1990-1999.”

you wrote:

“If anyone would like to know about the methdological difficulties of conducting studies of child nutrition in Iraq, and determining secular trends, this paper would seem to be a good choice (I haven’t read it, though, and it’s not available on line):”

It might be on line.
Garfield’s website
has a link to his Publications in “NLM’s PubMed,” which appears to be a professional data base. The article above is #5 on the list
the link displays. I don’t know how access works but you might. Good luck.

By the way, Garfield is one of the authors of the Lancet study. Small world. (; -)

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Donald Johnson 11.24.04 at 4:14 pm

Juan Cole’s post about the lack of moral equivalence was, frankly, a little odd coming from someone who thinks the Lancet study should be taken seriously and also given what he has said both before and after that one. I agree that one shouldn’t compare the actions of a soldier in combat (even if it turns out to be a war crime) to the cold-blooded killing of a hostage. One action is bad (if it was a war crime) but the other is worse. But Abu Ghraib is on the same level as hostage-killing, and bombing Fallujah with the hope (admitted in the press) that the suffering of the civilians would drive a wedge between them and the insurgents is what I’d call terrorism.

Rule of thumb–when someone says there is no moral equivalence between the actions of X and Y, there’s probably a good argument for saying that there is.

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Uncle Kvetch 11.24.04 at 8:23 pm

You will already have seen the extraordinary lengths the US has gone to protect civilians in the critical operation to secure Falluja for the Sistani backed elections, so I don’t have to mention that.

I have “seen” nothing of the kind.

We’ve been told about these “extraordinary lengths” by representatives of the US military, and by embedded reporters whose work (not to mention physical safety) is entirely dependent upon the approval of said military.

What I have “seen,” on the other hand, is that if civilians were endangered by US military actions, the Pentagon would see no compelling reason to tell us about it–nor would the “liberal media” see any reason to report it.

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Where's The Beef? 11.26.04 at 8:28 am

>>>The article makes grim reading for anyone concerned about winning the hearts and minds of the Iraqi people.

Are you moved to take action to aid these children? Are they on your Holiday wish list yet?

There are hospitals, schools, and food suppliers who have been risking their lives to do so. At least one prominent CARE worker has been butchered by the enemy simply for doing good deeds. The Red Cross workers and their depots are also targets of the enemy.

And more than a few people in Coalition and Iraqi uniforms have been at risk — some killed — in protecting the providers of aid.

Human shields may or may not be effective but I wonder how grim things need to get before someone among the commentators on this popular website organizes care packages or lobbies their Representatives to push for getting even more aid to the Iraqi people.

Maybe the voices of the American people can light a fire under the arses of the UN to get itself onside with the Iraqi people and make a full court press.

>>>What I would like to know is — are the Americans using the same Iraqi mass grave diggers that Saddam employed as they dump the “insurgent” bodies in Falluja. Wouldn’t that be neat? Getting an Iraqi industry back on its feet again. We really are a highly moral people.

There’s ambiguity in your bold remarks. Are you one of “the Americans” or are you one of the “highly moral people” you mock?

Look, if the death toll escalated among civilians to the extent that the Lancet has guesstimated, then, the volume of burials would hardly go unnoticed. That study and this new one on malnutirtion both would face a similar constraint in the collection of valid data. Their guesstimates deserve greater scrutiny all round.

As for the deaths of the enemy combattants, their aim was to kill women and men in uniform. To kill Iraqis and other Coaliton members in uniform. To kill civillians — Iraqis of all faiths, ethnicities, sexes, and ages. To demoralize the good people like yourself who watch from a distance. They’d kill you and me if they thought it would terrorize even more Americans and Iraqis. Want to come with me to see for yourself?

Besides, they ran their own little cottage industry in the manufacture of instruments of terror in Falluja. The dismembered and unburied bodies on their watch may be worthy of mockery as well, perhaps?

Reread your comments and see if you can return to tell the group her that you are proud of what you wrote.

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roger 11.27.04 at 2:30 am

Where’s the beef, you seem a little behind the news. Not only did I — disloyal to the occupation cause — think that the razing of Fallujah was an atrocity, but it seems to have made a big impression on “Iraqis of all faiths” — or at least, to be more honest, on Sunnis and Kurds. The U.S. policy has turned towards selecting ethnic and religious groups to victimize, the sort of strategy Milosovic used in the 90s in the breakup of Yugoslavia. The preferred victims: sunnis. The goal: associate Allawi with the revenge faction among the Shi’ite in order to prevent him from sinking in a possible free election into non-entity hood against Sadr.

Paranoid delusion? Well, something like that idea must animate our former good friend Adnan Adnan Pachachi — remember, the guy who sat behind Laura Bush at one of the CoC’s state of the union blatherfests? — and the two largest parties of Kurds, who are urging that elections be postponed now. Meanwhile, hawks like Charles Krauthammer salivate publicly about the U.S. “using factions”, ie promoting civil war, in order to promote its larger aim, hegemony in Iraq.

As for putting myself in harm’s way in Iraq — alas, I can barely afford to put myself in harm’s way in Austin, Texas, due to an economy that submits the low end wage earner, such as myself, to a punishing regime of unemployment and inflationary fiscal policy. So volunteering isn’t a charity I can afford. Which actually makes little difference — the idea that I am going to “help” Iraqis, whose language I don’t know, whose history shows a clear ability to help themselves, who suffer from a rate of unemployment that could allieviated to some extent if all those “helpful” Western tech folk were replaced by their Iraqi counterparts (pity the country whose unemployment problem is compounded by an influx of “helpful” Americans) and who, in my opinion, need to be disinvested of foreign forces — American, British, Wahabi, Iranian, etc. — rather than infested with further specimens of same.

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Where's The Beef? 11.27.04 at 7:32 am

roger, in this instance sophistry is both an unaffordable indulgence and an evasion of responsibility. Are you proud of the following comment you made upthread?

>>What I would like to know is — are the Americans using the same Iraqi mass grave diggers that Saddam employed as they dump the “insurgent” bodies in Falluja. Wouldn’t that be neat? Getting an Iraqi industry back on its feet again. We really are a highly moral people.

To reiterate to roger and to other commentators and readers here: if the post at the top of this thread nudged your complain-o-meter, have you plans to take action, or have you already taken action of some sort, to address the reported malnutrition in Iraq?

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